What I have found through my experiences with depressed people is that the vast majority of them are not insane people in a sane society, but perfectly sane people in an insane society, people who have maladapted to their environment but would otherwise (if they had a better one) be perfectly healthy individuals. Many of them internalize their sadness and helplessness and make it a part of their identity, further reinforcing the common belief among depressed people that they are ill at a biological level (and are not merely healthy people in an unhealthy environment). I don't think the solution to this is ever going to lay in the hands of psychologists, and certainly not psychiatrists (SSRI's and SNRI's work only slightly better than chance in most people, and taking other antidepressant/mood-stabilizing medication is a hellish experience all its own) - it lays in the hands of the people who construct the environment we live in, the people in charge of its development and health, the people who have the most power over society. These are the people who have destroyed it and made the environment we all have to live in such a hellish place, and their successors will certainly be the only people who can fix it.
Toward a Predictive Theory of Depression
71–80 of 121 posts
Re: Toward a Predictive Theory of Depression
#72Earlier quoted context omitted.
Without commenting on content, I will point out that the author of the article is a psychiatrist as well.
Yes. This is one reason I bothered to comment. Psychiatrists who step into the public space bear a particular obligation both to advocate for our patients and to push back against misinformation.
I don't think this article was meant to be widely shared, especially not in a public space like Hacker News. Alexander has a number of articles about depression grounded in actual established psychiatry and is, unsurprisingly, a big proponent of treating it - I'm not sure how you're getting "doesn't advocate for his patients" from this article. Also, it literally starts with the words "total wild speculation". It certainly looks like it's supposed to start a discussion rather than be informative.
Re: Toward a Predictive Theory of Depression
#73Earlier quoted context omitted.
Yes. This is one reason I bothered to comment. Psychiatrists who step into the public space bear a particular obligation both to advocate for our patients and to push back against misinformation.
I don't think this article was meant to be widely shared, especially not in a public space like Hacker News. Alexander has a number of articles about depression grounded in actual established psychiatry and is, unsurprisingly, a big proponent of treating it - I'm not sure how you're getting "doesn't advocate for his patients" from this article. Also, it literally starts with the words "total wild speculation". It cer…
There is Twitter and Facebook share buttons embedded in the article that was posted to a pretty high traffic blog...
Re: Toward a Predictive Theory of Depression
#74> Depression has to be about something more than just beliefs; it has to be something fundamental to the nervous system. Is he saying thoughts and beliefs aren't fundamental to the nervous system/CNS/brain? What if people get depressed because their lives suck and they had a shitty childhood? Also, why are women twice as likely to get depressed than men?[0] If "happiness is the derivative of neural confidence"... the…
> What if people get depressed because their lives suck and they had a shitty childhood? But people don't only get depressed because of those things; plenty of people's "lives suck" who aren't depressed, and plenty of people with good lives _are_ depressed. https://en.wikipedia.org/wiki/Major_depressive_disorder says: "The cause is believed to be a combination of genetic, environmental, and psychological factors....…
Beliefs are passed down like genes.
Re: Toward a Predictive Theory of Depression
#75Earlier quoted context omitted.
The current answer is we don’t yet have full functional pathologies of types of depression, noninvasive, specific mood disorders classified down to exact neurological dysfunctions, accurate and precise knowledge of how existing antidepressants work and evidenced-based application of particular therapies based on such scientifically-identified presentations. Clinical psychiatry has been mostly a scattergun, guesswork…
I've tried almost every anti depressant on the market and none of them worked. What did work for me is kratom. I've been taking it daily for about six months and it has completely turned around my mood and general enthusiasm. There are some minor side effects but they went away after six weeks or so. I know it might frowned upon to recommend what is basically an opiate for depression, but it has been a minor miracle…
And what if your depression is cause of beliefs/behaviors and not curable with pills?
Re: Toward a Predictive Theory of Depression
#76Umm, not sure this is universal but partial. Depression seems evolutionary psych for multiple, overlapping purposes: - Reducing aggression (and hence conflict) in larger groups. - Focusing on existential re/purpose by turning inward (ie find a new job/hobby/outlook/philosophy). Lots of reading, writing and ideation. Hopefully rebuild confidence/positivity with completing something. - Retreating for terminal resource…
Medication will stop working, it always does.
Re: Toward a Predictive Theory of Depression
#77Professor of psychiatry here - I've spent the past 20 years trying to help folks with depression, and related illnesses, and trying to study these diseases at a genetic level. I suspect this will get me down-voted as I know the medical/biological perspective is often unwelcome on hn. However: a key error people make here and elsewhere in speculating about depression (and suicide, and ADHD, and...) is either extrapola…
In my experience and observation, the physical world of the subject has been far too discounted.
And, I'll add, there are manifold variances in personal experiences and circumstances.
Why? Well, among other things, and in a simple reduction: Because the physical world is a "hard" problem. And one that does not involve just the subject him-/her-self.
Actually, also, in my observation, often the "hard" part isn't a determination of what should or needs to be done. It's finding the resources to accomplish this.
For example, remove people from their circumstances and sources of -- often extreme -- stress! (Or, enable them to do this, once they elect to. And/or effectively deal with the sources, themselves -- as an individual, a community, a society, or whatever effective agency.)
Yeah, but...
So, you come up with, as a profession, professionally blessed compensation mechanisms and assignment of responsibility to the subject -- perhaps, the victim -- instead.
I'm not saying everyone does this. Nor that all cases reduce to it. But, it is well worth considering, as a part of the continuing problem of mental illness and its treatment.
Re: Toward a Predictive Theory of Depression
#78No mention of sleep? * http://www.thelancet.com/journals/lanpsy/article/PIIS2215-03...
I think there's a lot of agreement that sleep is important, but not much consensus around models that are useful for treating it. Right now there's a big push for CBT-I, but the evidence is mostly low-quality and not really focused on anything except reducing subjective insomnia severity (this study is better than most in that respect).
Re: Toward a Predictive Theory of Depression
#79Professor of psychiatry here - I've spent the past 20 years trying to help folks with depression, and related illnesses, and trying to study these diseases at a genetic level. I suspect this will get me down-voted as I know the medical/biological perspective is often unwelcome on hn. However: a key error people make here and elsewhere in speculating about depression (and suicide, and ADHD, and...) is either extrapola…
I would hope the opposite is true, and that medical expertise is particularly welcomed and appreciated on HN (you aren't the only doctor here). Thank you for taking the time to comment!
Re: Toward a Predictive Theory of Depression
#80Earlier quoted context omitted.
Absolutely, but don't let this caveat stop you from considering this sort of advice if your depression has crossed that threshold. For those of us who have been there it's little strategies like this that keep us from crossing that threshold for too long.
As someone who’s been there, these tricks and tips make things worse, not better. Most depression advice is pretty terrible, this thread included.
My point is that people have to figure out what helps themselves. All of the terrible advice amounts to knowing there are people who have learned to manage themselves and therefore most people can learn to manage themselves.